Healthcare Provider Details

I. General information

NPI: 1255478483
Provider Name (Legal Business Name): FELICITY M GAZOWSKY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 03/22/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 CA-104
IONE CA
95640
US

IV. Provider business mailing address

PO BOX 723
DIAMOND SPRINGS CA
95619-0723
US

V. Phone/Fax

Practice location:
  • Phone: 209-274-4911
  • Fax:
Mailing address:
  • Phone: 530-306-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number31529
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: